One in three Canadians experience a mental health issue within their lifetime. Currently, more than 6.7 million people are living with a mental health condition in Canada. Mental health conditions occur across the life span, regardless of gender, race, sexual orientation or any other social location. More than 28% of people aged 20-29 experience a mental illness in a given year, and by the time people reach 40 years of age, 1 in 2 people in Canada will have had or have a mental illness. Mental health poses a significant cost to our economy. A recent study released by the Mental Health Commission of Canada (MHCC) reveals that the economic cost to Canada is at least $50 billion per year, which represents 2.8% of Canada’s 2011 gross domestic product (GDP). Health care, social services and income support costs make up the largest proportions of these costs, and further, the cost to businesses equaled more than $6 billion in lost productivity (from absenteeism, pre-senteeism and turnover) in 2011. This study predicts that over the next 30 years, the total cost to the economy will have added up to more than $2.5 trillion. Given the mounting evidence, mental health has become an issue that can no longer be ignored. The Canadian Mental Health Association (CMHA), which operates at the local, provincial and national levels across Canada, works towards a single mission: to make mental health possible for all. The vision of CMHA Ontario is a society that believes mental health is the key to well-being. We are a not-for-profit, charitable organization, funded by the Ontario Ministry of Health and Long-Term Care. Through policy analysis and implementation, agenda setting, research, evaluation and knowledge exchange, we work to improve the lives of people with mental health and addictions conditions and their families. As a leader in community mental health and a trusted advisor to Government, we actively contribute to health systems development through policy formulation and by recommending policy options that promote mental health for all Ontarians. We also provide support to the 31 local Branches of CMHA across the province that provide comprehensive mental health and addictions services to individuals in diverse communities across Ontario.
Key Messages for Ontario Budget 2014
CMHA Ontario commends the Government of Ontario for its ongoing and demonstrated commitment to mental health. Through the release of Open Minds, Healthy Minds: Ontario’s Comprehensive Mental Health and Addictions Strategy in 2011, the Government committed to investing $257 million over three years for child and youth mental health. Within the first three years of this strategy, the Government has supported the development of 18 Service Collaboratives, provided designated mental health workers and nurses in schools to support mental health services, and expanded telepsychiatry services, among dozens of other initiatives. As we look towards years four to 10 of the Mental Health and Addictions Strategy, CMHA Ontario recommends that the Government:
- Invest in Affordable Housing
- Enhance Income Security, including access to Education and Employment Supports
- Increase Investments to the Community Mental Health and Addictions Sector
Invest in Affordable Housing
Homelessness, a significant health care issue, continues to produce enormous costs to our economy. According to the MHCC, an estimated 150,000 to 300,000 people across Canada are homeless, which results in $1.4 billion each year in costs to the health care, justice and social services systems. Although there are many factors that contribute to homelessness, a recent backgrounder on housing and mental health developed by CMHA Ontario reveals that people with serious mental health conditions are disproportionately affected by homelessness. The consequences of homelessness tend to be more severe when coupled with a mental health condition. Individuals with serious mental health conditions frequently identify income and housing as the most important factors in achieving and maintaining their health. However, for many, finding and maintaining safe and affordable housing can be difficult. During periods of illness, individuals may be unable to work and/or experience a loss of income. Without adequate income and due to a shortage of affordable housing options, they may have difficulty paying rent and may eventually lose their home and household contents. Consequently, many individuals live in substandard housing that is physically inadequate, crowded, noisy and located in marginalized neighborhoods.
Housing designed for people with mental health conditions can contribute to significant cost savings for the health system. It costs $486 a day ($177,390 per year) to keep a person in a psychiatric hospital, compared to $72 per day ($26,280 per year) to house a person in the community with supports. Housing with supports gives an individual access to a range of housing options: supportive housing, supported housing, and rent supplements. Supportive housing provides assistance by staffing housing units with 24-hour supports. Other individuals may live in the larger community and have supports, such as homecare and counseling when they need it. This is referred to as supported housing.
CMHA Ontario commends the Government of Ontario for their ongoing commitment to providing affordable housing for Ontarians through the Long Term Affordable Housing Strategy. As of 2011, Ontario has:
- 260,000 public housing units;
- 41,454 co-operative housing units;
- 223,885 non-profit housing units;
- 2,201 urban Aboriginal housing units; and
- 11,317 dedicated supportive housing units
At the beginning of 2011, there were 152,077 low income households on active waiting lists for social housing in Ontario. With regards to housing with supports, as of 2012, the Government of Ontario provides housing with supports to 107,294 Ontarians in need. Of this number, dedicated mental health supportive housing assistance is available for 3,195 individuals and 430 persons with mental health conditions receive supports through room and board arrangements.
CMHA Ontario also commends the Government for the development of the Housing Allowance/Rent Supplement Program, a component of the broader Affordable Housing Program which is a partnership program cost-shared between the federal and provincial governments. The federal and provincial governments have each committed $301 million to the program, and including municipal contributions, the total investment by all levels of government is at least $734 million. This program provides a housing allowance, which is a supplement paid to the landlord on behalf of households in need of rental assistance. The rent supplement is intended to help bridge the difference between the rent that a household can afford to pay and the actual market rent. In addition, the Ministry of Health and Long-Term Care also provides rent supplements to 6,742 individuals with mental health conditions. CMHA Ontario calls on the Government for increased funding for additional rent supplements across the province as rent supplements can be used to help finance a new supply of supportive housing units as well help supportive housing providers leverage private capital for new construction.
Moving forward, CMHA Ontario recommends further investments for a Housing First model across Ontario to support marginalized populations. Housing First is an approach where housing is provided as the first step, in combination with supportive services, to people who are homeless and living with mental health and addictions issues. This approach is based on the notion that the first and most primary need for people is housing, and that any other issues a person is living with can be addressed once a person has housing. Findings from At Home/Chez Soi, MHCC’s recent Housing First pilot project which was conducted in five major Canadian cities, revealed that for every dollar that is spent on Housing First, $1.54 is saved through the reduction in other costs for shelter, health and justice services.
CMHA Ontario recommends that the Government of Ontario invest in affordable housing by:
- Developing a Housing First model across Ontario to support marginalized populations, where housing is provided as the first step, in combination with supportive services, to people who are homeless and living with mental health and addictions issues;
- Supporting continued investments to and implementation of Ontario’s Long Term Affordable Housing Strategy, with a special focus on providing housing for individuals with mental health and addictions conditions; and
- Ensuring that any current and new investments in housing provide access to a range of housing options, including supportive housing, supported housing, and rent supplements for vulnerable populations, including those with mental health and addictions needs.
Enhance Income Security, including access to Education and Employment Supports
Income is an important social determinant of health. There is a large body of evidence that illustrates the causal effect between income and health. Those with lower incomes generally report poorer physical and mental health than those in the higher income quintiles. For example, a recent Canadian Medical Association poll stated that only 39% of the poorest Canadians report excellent or very good health, compared to 68% of the richest Canadians. According to Statistics Canada, Canadians in the lowest-income bracket are 3 to 4 times more likely than those in the highest-income bracket to say that their mental health is fair to poor.
In a recent CMHA Ontario submission to Ontario’s Minimum Wage Advisory Panel, we stated that the minimum wage should be increased to a level that provides for a decent standard of living and raised annually to adjust for increases to the cost of living. Minimum wage should be implemented in such a way as to enable a pathway out of poverty for those earning an income, without jeopardizing the economic health of Ontario businesses and their employees and with the knowledge that legislative changes are feasible within the timeframe indicated. Furthermore, we called for incremental increases to the minimum wage over a five-year period.
Successfully engaging workers with physical and mental health-related disabilities in the labour market is crucial, not only for improving their own physical and mental well-being, but also for strengthening overall economic growth, equality and social cohesion. However, stigma and discrimination can create significant barriers that prevent a successful job entry. Research indicates that only 10 – 20% of persons with the most serious mental illnesses are even in the workforce. The reality is, persons with disabilities, especially workers with severe mental health issues, also receive income support, and only work part-time to supplement their disability income. For many, the Ontario Disability Support Program (ODSP) is their first and only source of income. In 2008, 35% of persons with mental illnesses were in receipt of disability income support. This number has been steadily increasing, with mental illnesses becoming the primary diagnosis in new ODSP caseloads.
One cannot talk about quality employment without addressing its companion: market appropriate education and training. There is a strong correlation between low levels of education and low wage employment. Skills training refers to soft skill development (time management, social skill development), basic literacy training, as well as the workplace specific skills needed to perform a job. Providing skills training and/or post-secondary education to individuals will address the shortage of skilled labour, while moving a significant number of individuals out of poverty. The cost of not providing these supporting activities will amount to 5.5 to 6.6 percent of the GDP, through loss in economic activity. By comparison, investing in training for low income adults would generate additional revenue of $1 to $1.5 billion, by increasing economic output, thus increasing the GDP.
A healthy and productive workplace is vital to a person’s mental health, and mental health is a significant issue that affects the workplace. According a recent study commissioned by the MHCC, 21.4% of the working population in Canada currently experience mental health conditions, which can affect their productivity. Moreover, mental health conditions account for approximately 30% of short- and long-term disability claims and are rated one of the top three drivers of such claims by more than 80% of Canadian employers. If unaddressed, the impact of mental health conditions on lost productivity will cost Canadian businesses $198 billion over the next 30 years.
To address the growing mental health issues in the workplace, CMHA Ontario provides employer solutions through a nationally available program, Mental Health Works (www.mentalhealthworks.ca). Mental Health Works builds capacity within Canadian workplaces to effectively address the many issues related to mental health in the workplace. CMHA Ontario also actively supported the development of the voluntary National Standard for Psychological Health and Safety in the Workplace, an initiative lead by the MHCC, which is an action plan for addressing the growing mental health needs in the workplace, the first of its kind in the world.
CMHA Ontario recommends that the Government of Ontario invest in income security by:
- Incrementally increasing the minimum wage of $10.25 over 5 years to reach a wage of 10% above the poverty line by 2018. We call for incremental increases to the minimum wage over a five-year period, instead of a one-time increase with the recognition that minimum wage alone cannot reduce poverty; rather it is just one tool in the arsenal of tools that can be used to narrow the poverty gap;
- Expanding employment services to include a full range of employment readiness activities (such as soft skill development), a more extensive job coaching component than is currently funded, and a focus on building individual capacity and skills; and
- Promoting workplace mental health by adopting the voluntary National Standard for Psychological Health and Safety in the Workplace within the Ontario Public Service, as well as recommending its adoption to all government-funded agencies; and supporting community-based programs, such as Mental Health Works, to address the mental health needs of employers and employees in the workplace.
Increase Investments to the Community Mental Health and Addictions Sector
CMHA Ontario commends the Government of Ontario for the demonstrated commitment to promoting mental health for all Ontarians by developing the Action Plan for Health Care and Ontario’s first ever Mental Health and Addictions Strategy. These strategies highlight the value of investing in the community to improve access to health care for Ontarians and overall health system efficiency. Reflecting this, funding was increased for the community mental health and addictions sector by 4% in 2012, and an additional 1% in 2013. CMHA Ontario calls on the Government for a further increase in funding by 4%. We understand that most of the new investments over the past few years were directed to new programs; as such, CMHA Ontario calls on the Government to increase funding to the base budget for existing community mental health and addictions programs. Given the growing social and economic costs and needs associated with mental health and addictions in Ontario, as well as the critical role played by the community mental health and addictions system in reducing costs and meeting needs, it is essential to maintain and enhance these funding increases for this part of the health system.
In 2011-2012, Ontario spent $47 billion on health care. However, provincial spending on community mental health services and supportive housing accounts for only 1.31% of health spending. The Commission on the Reform of Ontario’s Public Services, led by Don Drummond, echoed this reality by stating that 75% of mental health care happens outside the formal health care system. A continued increase in investments to the community mental health and addictions sector is necessary for advancing the Action Plan for Health Care and the Mental Health and Addictions Strategy and ensuring the right care at the right time at the right place for all Ontarians.
Finding solutions to mental health and addictions issues across the province requires a collaborative, integrated, and inter-ministerial approach. CMHA Ontario applauds the Government of Ontario for their collaborative approach to addressing the mental health and addictions needs of Ontarians. More than ever before, multiple Government ministries are actively engaged in addressing mental health and addictions issues and this collaborative, inter-ministerial approach is evident in the development and implementation of the Mental Health and Addictions Strategy. In the midst of this collaboration, it is important to keep in mind that the implications for health must be embedded in policy development and implementation across different government ministries, and therefore, any public policy that affects a key determinant of health should be viewed through a Health in All Policies approach. Ensuring that government policies are integrated to their fullest ability will help ensure that a change in one government policy does not have unintended negative consequences for marginalized populations, including those with mental health and addictions needs.
CMHA Ontario recommends that the Government of Ontario increase investments to the community mental health and addictions sector by:
- An additional 4% in fiscal 2014-15.
- Continuing to invest in Ontario’s 10-year Mental Health and Addictions Strategy, with a focus on the adult and seniors populations in years four to ten; and
- Adopting a Health in All Policies approach within government policies. This will ensure that a change in one government policy does not have unintended negative consequences for marginalized individuals, including those with mental health and addictions needs.
Our Commitment to Ontario
The Canadian Mental Health Association, Ontario is committed to assisting the Government of Ontario, and specifically the Ministry of Health and Long-Term Care, find solutions to health care challenges that impact the quality of life for persons living with mental health and addictions conditions. By investing in a range of housing options, enhancing the current income support system and informing changes to the community mental health sector, CMHA Ontario believes that together we can identify solutions that put Ontarians’ health first. CMHA Ontario welcomes the opportunity to work with the Government to ensure that prevention of mental illnesses and the promotion of mental health remains a priority for Ontario. For further discussion, please contact: Camille Quenneville CEO Canadian Mental Health Association, Ontario 180 Dundas Street West, Suite 2301, Toronto ON M5G 1Z8 416-977-5580 ext. 4126 firstname.lastname@example.org www.ontario.cmha.ca
For more information and complete list of references, download the PDF of the submission.